Governing biotechnology to provide safety and security and address ethical, legal, and social implications

The field of biotechnology has produced a wide variety of materials and products which are rapidly entering the commercial marketplace. While many developments promise revolutionary benefits, some of them pose uncertain or largely untested risks and may spur debate, consternation, and outrage from individuals and groups who may be affected by their development and use. In this paper we show that the success of any advanced genetic development and usage requires that the creators establish technical soundness, ensure safety and security, and transparently represent the product's ethical, legal, and social implications (ELSI). We further identify how failures to address ELSI can manifest as significant roadblocks to product acceptance and adoption and advocate for use of the "safety-by-design" governance philosophy. This approach requires addressing risk and ELSI needs early and often in the technology development process to support innovation while providing security and safety for workers, the public, and the broader environment. This paper identifies and evaluates major ELSI challenges and perspectives to suggest a methodology for implementing safety-by-design in a manner consistent with local institutions and politics. We anticipate the need for safety-by-design approach to grow and permeate biotechnology governance structures as the field expands in scientific and technological complexity, increases in public attention and prominence, and further impacts human health and the environment.

Can Comorbidity Data Explain Cross-State and Cross-National Difference in COVID-19 Death Rates?

Many efforts to predict the impact of COVID-19 on hospitalization, intensive care unit (ICU) utilization, and mortality rely on age and comorbidities. These predictions are foundational to learning, policymaking, and planning for the pandemic, and therefore understanding the relationship between age, comorbidities, and health outcomes is critical to assessing and managing public health risks. From a US government database of 1.4 million patient records collected in May 2020, we extracted the relationships between age and number of comorbidities at the individual level to predict the likelihood of hospitalization, admission to intensive care, and death. We then applied the relationships to each US state and a selection of different countries in order to see whether they predicted observed outcome rates. We found that age and comorbidity data within these geographical regions do not explain much of the international or within-country variation in hospitalization, ICU admission, or death. Identifying alternative explanations for the limited predictive power of comorbidities and age at the population level should be considered for future research.

Migrant carers in Europe: double jeopardy of labour market exploitation and hostile environments

Background

Many health systems have responded to growing population needs and expanded long-term care services for older people (LTC). However, no country managed to adequately increase the human resources for health. A large group of transnationally mobile migrant carers fill the gaps and mitigate policy failure. This study aims to explore the connections between health labour markets, migrant care workers and populism and to reveal blind spots in the governance of the LTC workforce.

Methods

An explorative comparative approach was applied, which draws on a rapid review of the literature, public statistics and document analysis. A novel analytical framework was developed, which is informed by transsectoral governance and combines four major dimensions: LTC system (e.g. cash benefits, public responsibility), health labour market situation (supply-demand) in the LTC sector, labour migration policies relevant for LTC, and the role of populist parties. Five EU countries were selected which represent different conditions in LTC: Austria, Denmark, Germany, Italy and Poland.

Results

Typologies of sending and receiving countries are no longer sustainable, but transnational mobility flows still impact differently in healthcare systems and national labour markets. Undersupply coupled with cash-benefits and a culture of family responsibility are predicting high inflows of migrant carers, who are channelled in low-level positions or in the informal care sector. These conditions can often be observed in countries with strong populist movements.

Conclusions

Health labour markets, LTC systems, culture and political factors combine to create a double jeopardy for migrant carers, exploited as labour market subjects and exposed to hostile social environments as individual citizens. Action has to be taken to improve public health advocacy for migrant carers and to establish effective European health labour market regulation and transnational health workforce governance.

Migrant carers in Europe in times of COVID-19: a call to action for European health workforce governance and a public health approach

The present study explores the situation of migrant carers in long-term care (LTC) in European Union Member States and the disruptions caused by the COVID-19 pandemic from a public health perspective. The aim is to bring LTC migrant carers into health workforce research and highlight a need for trans-sectoral and European heath workforce governance. We apply an exploratory approach based on secondary sources, document analysis and expert information. A framework comprising four major dimensions was developed for data collection and analysis: LTC system, LTC health labour market, LTC labour migration policies and specific LTC migrant carer policies during the COVID-19 crisis March to May 2020. Material from Austria, Italy, Germany, Poland and Romania was included in the study. Results suggest that undersupply of carers coupled with cash benefits and a culture of family responsibility may result in high inflows of migrant carers, who are channelled in low-level positions or the informal care sector. COVID-19 made the fragile labour market arrangements of migrant carers visible, which may create new health risks for both the individual carer and the population. Two important policy recommendations are emerging: to include LTC migrant carers more systematically in public health and health workforce research and to develop European health workforce governance which connects health system needs, health labour markets and the individual migrant carers.